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Child's Nervous System

, Volume 34, Issue 8, pp 1489–1495 | Cite as

Distinct demographic profile and molecular markers of primary CNS tumor in 1873 adolescent and young adult patient population

  • Rohit Vadgaonkar
  • Sridhar Epari
  • Girish Chinnaswamy
  • Rahul Krishnatry
  • Raees Tonse
  • Tejpal Gupta
  • Rakesh Jalali
Original Paper

Abstract

Introduction

We present detailed demographic profile, tumor types, and their molecular markers in adolescent and young adult (AYA) patients of age group between 15 and 39 years with primary central nervous system (PCNS) tumors, and compare with pediatric and adult patient populations.

Methodology

Demographic- and disease-related information of 1873 PCNS tumor patients of age 15–39 years registered between 1 January 2011 and 31 December 2015 at our institution was analyzed with respect to their demographics and tumor subtypes. Various molecular markers for glial tumors and subgroup classification of medulloblastoma were evaluated for AYA, pediatric, and older adult patient populations.

Results

AYA constituted 27% of all PCNS. Median age was 29 years. Glial tumors (62.36%) comprised the largest tumor type with astrocytoma (38.55%) being the most common histology. Glioblastoma (51.52%) was the commonest astrocytic tumor with 74.67% of them being isocitrate dehydrogenase 1 (IDH1) negative and 41.38% with O (6)-methylguanine DNA methyltransferase (MGMT) promoter methylated. Diffuse astrocytoma and glioblastoma showed significantly higher IDH1 positivity and loss of alpha-thalassemia/mental retardation syndrome X-linked (ATRX) for AYAs as compared to pediatric and adult patient populations (p < 0.0001). Medulloblastoma (73.8%) was the most commonly diagnosed embryonal tumor, with sonic hedgehog (SHH) being the commonest molecular subtype (48%). Younger patients among AYA population presents with pediatric type of tumor spectrum, while older ones present with more aggressive tumor subtypes.

Conclusion

This is among the few studies reporting spectrum of PCNS tumor in AYA population with distinct tumor subtypes and molecular profiles. AYA patient populations may need special attention with appropriately designed clinical trials.

Keywords

Gliomas Medulloblastoma Adolescent and young adults Teenage and young adults 

Introduction

With more than five decades of focus of oncology on management of two broad cancer patient populations of either pediatric or adults, a gradual but definite shifting of attention towards adolescent and young adults (AYA) between the ages of 15 and 39 years is being witnessed lately [1]. It has been seen that the global burden of cancer in AYA is substantial and seems to be increasing [1]. Primary central nervous system (PCNS) tumor comprises 1–2% of all neoplasm and is the third most common cancer in AYA, with an age-adjusted incidence of 10.43 per 100,000 population [2]. This age is considered as a distinct phase of life and is characterized by rapid changes in cognitive and emotional growth [3]. Being also perhaps the most productive years of life, diagnosis of cancer in this age has been shown to result in a major detriment in physical and psychosocial aspects [4]. It is increasingly recognized that this particular age group probably warrants a better attention to address not only the clinical outcome measure but also issue of patient-reported outcomes and survivorship [5]. On the contrary, it has been observed that AYA cancer populations receive relatively less attention as well as low participation in clinical trials [6].

Recently published data by the Central Brain Tumor Registry of United States (CBTRUS) has provided a new insight into AYA in neuro-oncology practice [2]. We therefore undertook the present study to evaluate the incidence of PCNS tumors in AYAs at our institution with an aim to study their spectrum of clinical, histopathological, and molecular distribution of various tumor subtypes.

Materials and methods

Demographic- and disease-related information for all consecutively registered patients between 1st January 2011 and 31st December 2015, at Tata Memorial Centre (TMC), Mumbai, Neuro-Oncology Disease Management Group was recorded prospectively (n = 6892). Data for patients with age group of 15 to 39 years were identified (n = 2049). Patients’ age, sex, histopathological diagnosis, radiological location of tumor, and available molecular markers were included. All primary intracranial brain and spine tumors codified under the World Health Organization 2007 classification were included [7]. Along with these, tumors of the pituitary gland and craniopharyngiomas codified under the International Classification of Diseases for Oncology, Third Edition [8], were also included. Metastatic (n = 44), bony tumors (n = 11), other benign and cystic lesions like tuberculomas, arachnoid cysts, colloid cysts, epidermoid cysts, and artero-venous malformations (n = 60) were excluded from analysis. Diagnosis was missing for 61 (2.9%) patients. Hence, a data of 1873 patients belonging to the age group 15–39 years fulfilling the above criteria were used for analysis.

A detailed review of available radiological imaging either computed tomography or magnetic resonance imaging was done. A large majority of our patients are operated upon at other centers with a pathology diagnosis of a CNS tumor and referred for their further management. Our institution is a tertiary care-dedicated cancer center and all outside patients have their histology reviewed and confirmed by our expert neuropathologists (SE, co-author). In many instances, additional molecular markers and a review of the entire histology with imaging and clinical details is done in the unit’s twice weekly multidisciplinary joint neuro-oncology meeting for accurate diagnosis. Multifocal tumors were assigned location based on the largest component of tumors. Isocitrate dehydrogenase 1 (IDH1)-mutational status, p53, and alpha-thalassemia/mental retardation syndrome X-linked (ATRX) were determined by immunohistochemistry. O (6)-methylguanine DNA methyltransferase (MGMT) promoter methylation status was evaluated by methylation-specific polymerase chain reaction (PCR). Data on subgroup classification depending upon predominant signaling pathways was available for 25 medulloblastoma patients and these were subclassified into four groups: wingless (WNT), sonic hedgehog (SHH), group 3, and group 4. The subgroup analysis was performed as per our published institutional protocol of RT-PCR-based technique of identifying unique microRNA and protein-coding genes [3]. Representative, unpublished data for the single calendar year 2015 of all registered patients in Neuro-DMG of TMC was used for comparison. Out of total 1437 registered patients in the year 2015, 227 (15.73%) were less than 15 years of age, 456 (31.73%) were of AYA age group, and 779 (54.21%) were of greater than 39 years of age. Among these, 202 (88.98%) of pediatric, 426(93.42%) of AYA, and 592 (75.99%) of older adults, fulfilling same inclusion criteria were compared.

The data was codified and statistical analysis was carried out using SPSS version 20 (SPSS, Inc., Chicago, IL, USA) and various charts and graphs were generated. Pearson’s chi-square test was used to calculate the statistical significance and p value of < 0.05 was considered as statistically significant.

Results and observations

AYA population constituted 27% (range 24 to 29%) of all cases (Fig. 1a). Studied population comprised 1225 (65.4%) males and 648 (34.6%) females (Fig. 1b). Median age was 29 years. Glial tumors were the most frequently observed PCNS neoplasm, comprising 62.36%. Among these, astrocytoma (38.55%) was the most common, followed by oligodendroglioma (ODG) (9.98%). Embryonal tumors comprised 6.51%, whereas pituitary tumors constituted 8.43%. Primary CNS lymphomas (PCNSL) constituted less than 1% of all patients (Table 1). Among astrocytoma, glioblastoma was the commonest diagnosis comprising 51.52%, whereas medulloblastoma (73.8%) was the most commonly diagnosed embryonal tumor. All tumors were seen more frequently in males (n = 1225, 65.4%), except pituitary tumors which were observed to be slightly more common in females (53.16 versus 46.84%) (Table 2). Data on primary location of tumor was available for 1817 (97.1%) patients. The cerebrum was the most common site of presentation constituting 53.27% and the most common location was frontal lobe (30.46%), followed by temporal lobe (15.06%), whereas 7.31% of tumors were observed to be infra-tentorial origin and 3.63% tumors were limited to spinal cord. Age-wise distribution of location of PCNS tumors is shown in supplementary Table 1.
Fig. 1

a Year-wise distribution of all registered primary CNS tumors. b Year-wise distribution of AYA patients according to gender

Table 1

Distribution of AYA population according to age and gender

Age (years)

2011

2012

2013

2014

2015

Total

Male

Female

Male

Female

Male

Female

Male

Female

Male

Female

Male

Female

15–19

35

34

28

13

40

13

39

15

43

22

185

97

20–24

29

14

30

20

46

20

46

25

33

18

184

97

25–29

36

30

41

14

69

20

68

14

57

35

271

113

30–34

49

25

54

32

67

44

61

35

71

41

302

177

35–39

40

19

47

32

73

37

56

37

67

39

283

164

Total

189

122

200

111

295

134

270

126

271

155

1225

648

Table 2

Detailed distributions of histologically diagnosed cases

Histological diagnosis

Age group

Sex

15–19

20–24

25–29

30–34

35–39

Total

Male

Female

Total

Astrocytomas

96 (13.3%)

102 (14.13%)

146 (20.22%)

211 (29.22%)

167 (23.13%)

722 (100%)

500 (69.25%)

222 (30.75%)

722 (100%)

Pilocytic

38 (44.71%)

14 (16.47%)

12 (14.12%)

12 (14.12%)

9 (10.58%)

85 (100%)

57 (67.05%)

28 (32.95%)

85 (100%)

Pleomorphic xanthoastrocytoma

9 (36%)

8 (32%)

5 (20%)

3 (12%)

0 (0%)

25 (100%)

19 (80%)

6 (20%)

25 (100%)

Diffuse

14 (12.5%)

15 (13.39%)

23 (20.54%)

35 (31.25%)

25 (22.32%)

112 (100%)

67 (59.82%)

45 (40.12%)

112 (100%)

Anaplastic

4 (3.12%)

17 (13.28%)

30 (23.44%)

45 (35.16%)

32 (25%)

128 (100%)

93 (72.65%)

35 (27.35%)

128 (100%)

Glioblastoma

31 (8.33%)

48 (12.91%)

77 (20.7%)

116 (31.18%)

100 (26.88%)

372 (100%)

264 (70.97%)

108 (29.03%)

372 (100%)

Oligoastrocytoma

9 (4.92%)

22 (12.02%)

33 (18.03%)

62 (33.89%)

57 (31.14%)

183 (100%)

121 (66.12%)

62 (33.88%)

183 (100%)

Oligodendroglioma

6 (3.21%)

21 (11.23%)

41 (21.92%)

57 (30.48%)

62 (33.16%)

187 (100%)

122 (65.24%)

65 (34.76%)

187 (100%)

Brainstem glioma

24 (31.58%)

15 (19.74%)

16 (21.05%)

10 (13.16%)

11 (14.47%)

76 (100%)

59 (77.63%)

17 (22.37%)

76 (100%)

Embryonal tumors

46 (37.7%)

24 (19.67%)

23 (18.85%)

13 (10.66%)

16 (13.12%)

122 (100%)

86 (70.49%)

36 (29.51%)

122 (100%)

Medulloblastoma

29 (32.22%)

19 (21.11%)

17 (18.89%)

11 (12.22%)

14 (15.56%)

90 (100%)

68 (75.56%)

22 (24.44%)

90 (100%)

PNET

13 (46.43%)

5 (17.86%)

6 (21.43%)

2 (7.14%)

2 (7.14%)

28 (100%)

15 (53.57%)

13 (46.43%)

28 (100%)

Ependymal tumor

24 (30%)

11 (13.75%)

15 (18.75%)

17 (21.25%)

13 (16.25%)

80 (100%)

51 (63.75%)

29 (36.25%)

80 (100%)

Tumor of pineal region

7 (33.33%)

6 (28.57%)

3 (14.29%)

2 (9.52%)

3 (14.29%)

21 (100%)

13 (61.9%)

8 (38.1%)

21 (100%)

Neuronal and mixed neuroglial tumor

7 (21.21%)

8 (24.24%)

9 (27.27%)

5 (15.16%)

4 (12.12%)

33 (100%)

22 (66.7%)

11 (33.3%)

33 (100%)

Meningioma

6 (8.22%)

9 (12.33%)

17 (23.28%)

13 (17.81%)

28 (38.36%)

73 (100%)

37 (50.68%)

36 (49.32%)

73 (100%)

Nerve sheath tumor

3 (6.38%)

5 (10.64%)

11 (23.4%)

20 (42.56%)

8 (17.02%)

47 (100%)

24 (51.06%)

23 (48.94%)

47 (100%)

Pituitary tumor

15 (9.49%)

26 (16.46%)

34 (21.52%)

33 (20.88%)

50 (31.65%)

158 (100%)

74 (46.84%)

84 (53.16%)

158 (100%)

Craniopharyngioma

20 (40%)

9 (18%)

6 (12%)

9 (18%)

6 (12%)

50 (100%)

32 (64%)

18 (36%)

50 (100%)

PCNSL

0 (0%)

4 (22.22%)

4 (22.22%)

5 (27.78%)

5 (27.78%)

18 (100%)

12 (66.67%)

6 (33.33%)

18 (100%)

PNET primitive neuroectodermal tumor, PCNSL primary CNS lymphoma

Molecular analysis showed 74.67% of glioblastoma were IDH1 negative and 41.38% had MGMT promoter methylated (Table 3). Among medulloblastoma, predominant subgroup was SHH seen in 12 (48%), followed by Group 3 in 6 (24%), Group 4 in 5 (20%), and WNT in 2 (8%) patients. This AYA data was further compared with representative data of the year 2015 for all age groups and with the CBTRUS database [2] (Table 4).
Table 3

Molecular profiles of tumors in AYA

Molecular markers

Test result

Anaplastic astrocytoma

Glioblastoma

Oligoastrocytoma

Oligodendroglioma

IDH1

Positive

25 (49.02%)

38 (25.33%)

42 (82.35%)

45 (67.16%)

Negative

26 (50.98%)

112(74.67%)

09 (17.65%)

22 (32.84)

Total

51 (100%)

150 (100%)

51 (100%)

67 (100%)

ATRX

Loss

25 (69.44%)

54 (56.84%)

05 (41.67%)

03 (8.11%)

Retained

11 (30.56%)

41 (43.16%)

07 (58.33%)

34 (91.89%)

Total

36 (100%)

95 (100%)

12 (100%)

37 (100%)

p53

Positive

85 (92.39%)

199 (86.52%)

98 (79.03%)

68 (61.26%)

Negative

07 (7.61%)

31 (13.48%)

26 (20.97%)

43 (38.74%)

Total

92 (100%)

230 (100%)

124 (100%)

111 (100%)

MGMT

Methylated

09 (40.91%)

36 (41.38%)

10 (71.43%)

NA

Unmethylated

13 (59.09%)

51 (58.62%)

04 (28.57%)

NA

Total

22 (100%)

87 (100%)

14 (100%)

NA

1p19q

Co-deleted

NA

NA

08 (15.09%)

33 (63.46%)

Non-co-deleted

NA

NA

45 (84.91%)

19 (36.54%)

Total

NA

NA

53 (100%)

52 (100%)

Table 4

Comparison of AYA data of TMH with cases registered in 2015 and with CBTRUS data

 

< 15 years, TMH (2015)

40+, TMH (2015)

AYA, TMH (2011–2015)

AYA, CBTRUS (2008–2012)

Astrocytoma

53 (26.2%)

344 (58.11%)

722 (38.55%)

8121 (15.3%)

Pilocytic

26 (12.9%)

08 (1.33%)

85 (4.54%)

1519 (2.9%)

Diffuse/infiltrative

03 (1.49%)

17 (2.86%)

112 (5.98%)

2413 (4.5%)

PXA

03 (1.49%)

00 (0%)

25 (1.33%)

NS

Anaplastic

01 (0.5%)

30 (5.1%)

128 (6.83%)

1398 (2.6%)

Glioblastoma

20 (9.9%)

289 (48.81%)

372 (19.86%)

2393 (4.5%)

Oligoastrocytoma

00 (0%)

24 (4.05%)

183 (9.77%)

1333 (2.5%)

ODG

02 (0.9%)

48 (8.11%)

187 (9.98%)

1488 (2.8%)

Brainstem glioma

38 (18.81%)

03 (0.51%)

76 (4.06%)

NS

Embryonal

67 (33.17%)

02 (0.34%)

122 (6.51%)

915 (1.7%)

Medulloblastoma

50 (24.75%)

01 (0.17%)

90 (4.8%)

NS

PNET

13 (6.53%)

01 (0.17%)

28 (1.49%)

NS

Ependymoma tumor

17 (8.52%)

05 (0.84%)

80 (4.27%)

1888 (3.6%)

Pineal tumor

02 (0.9%)

03 (0.51%)

21 (1.12%)

258 (0.5%)

NMN

01 (0.5%)

01 (0.17%)

33 (1.76%)

1773 (3.3%)

Meningioma

01 (0.5%)

66 (11.14%)

73 (3.89%)

8440 (15.9%)

Nerve sheath tumor

00 (0%)

18 (3.04%)

47 (2.51%)

4545 (8.6%)

Pituitary tumors

01 (0.5%)

31 (5.24%)

158 (8.44%)

15,892 (29.9%)

Craniopharyngiomas

09 (4.46%)

04 (0.68%)

50 (2.68%)

667 (1.3%)

PCNSL

00 (0%)

34 (5.74%)

18 (0.97%)

576 (1.1%)

Others

11 (5.44%)

09 (1.52%)

103 (5.49%)

NS

Total

202 (100%)

592 (100%)

1873 (100%)

53,083 (100%)

ODG oligodendroglioma, PXA pleomorphic xanthoastrocytoma, PNET primitive neuroectodermal tumor, NMN neuronal and mixed neuroglial tumors, PCNSL primary CNS lymphoma

Table 5 shows comparison of molecular profile for all registered patients in a single calendar year of 2015.Diffuse astrocytoma and glioblastoma showed significantly higher IDH1 positivity (χ2 = 32.851, p < 0.0001 and χ2 = 26.705, p < 0.0001 respectively). Also, these tumors showed significantly higher loss of ATRX in AYAs (χ2 = 74.485, p < 0.0001 and χ2 = 69.005, p < 0.0001 respectively). However, no significant difference was observed for MGMT methylation status (χ2 = 3.468, p = 0.1766 and χ2 = 3.507, p = 0.173 respectively).
Table 5

Comparison of molecular profiles of patients registered in 2015

Molecular marker

Tumors

Result

< 15 years (n = 202)

15–39 years (n = 426)

40+ years (n = 592)

Test of significance

IDH1 mutation

Diffuse astrocytoma

Positive

0 (0%)

44 (32.1%)

26 (10.7%)

χ2 = 32.851

p < 0.0001

Negative

22 (100%)

93 (67.9%)

217 (89.3%)

Total

22 (100%)

137 (100%)

243 (100%)

Glioblastoma

Positive

0 (0%)

21 (24.1%)

11 (5.2%)

χ2 = 26.705

p < 0.0001

Negative

18 (100%)

66 (75.9%)

202 (94.8%)

Total

18 (100%)

87 (100%)

213 (100%)

ODG

Positive

01 (100%)

27 (81.8%)

26 (76.5%)

χ2 = 0.55

p = 0.7573

Negative

00 (0%)

06 (18.2%)

08 (23.5%)

Total

01 (100%)

33 (100%)

34 (100%)

ATRX

Diffuse astrocytoma

Retained

15 (62.5%)

45 (37.8%)

171 (84.6%)

χ2 = 74.485

p < 0.0001

Loss

09 (37.5%)

74 (62.2%)

31 (15.4%)

Total

24 (100%)

119 (100%)

202 (100%)

Glioblastoma

Retained

10 (52.6%)

31 (42.5%)

166 (90.2%)

χ2 = 69.005

p < 0.0001

Loss

09 (47.4%)

42 (57.5%)

18 (9.8%)

Total

19 (100%)

73 (100%)

184 (100%)

ODG

Retained

02 (100%)

30 (93.7%)

30 (93.7%)

χ2 = 0.133

p = 0.9356

Loss

00 (0%)

02 (6.3%)

02 (6.2%)

Total

02 (100%)

32 (100%)

32 (100%)

MGMT methylation

Diffuse astrocytoma

Methylated

00 (0%)

24 (36.9%)

40 (29.4%)

χ2 = 3.468

p = 0.1766

Unmethylated

05 (100%)

41 (63.1%)

96 (70.6%)

Total

05 (100%)

65 (100%)

136 (100%)

Glioblastoma

Methylated

00 (0%)

18 (40%)

40 (32%)

χ2 = 3.507

p = 0.173

Unmethylated

05 (100%)

27 (60%)

85 (68%)

Total

05 (100%)

45 (100%)

125 (100%)

 

Medulloblastoma

WNT

04 (26.8%)

02 (22.2%)

01 (100%)

χ2 = 2.831

p = 0.8298

SHH

04 (26.8%)

03 (33.3%)

00 (0%)

Group 4

02 (13.4%)

01 (11.2%)

00 (0%)

Group 3

05 (33.3%)

03 (33.3%)

00 (0%)

Total

15 (100%)

09 (100%)

01 (100%)

ODG oligodendroglioma

Discussion

Our study is likely to be one of the largest single institution studies focusing on PCNS neoplasm in AYA patient population. AYA group constituted 27% of all PCNS patient population, which has remained more or less constant over the study period and was seen to be lower than that of older adults (48.52%) but slightly higher than the pediatric population (16.56%). Our findings are in concordance with CBTRUS data [2]. The most common histology in the present study was astrocytoma (38.55%), which was the second most common diagnosis (15.3%) after pituitary tumors (29.9%) in CBTRUS data. CBTRUS is a population-based registry, whereas our registry is a hospital-based neuro-oncology centric database that may not incorporate all patients with benign histological diagnoses. This may also be the likely reason to explain lesser number of meningioma (3.89 versus 15.89%) and pituitary tumor (8.44 versus 29.9%) seen in our data as compared to the CBTRUS analysis. Slight difference in other glial, embryonal, and ependymal tumors between CBTRUS and our data may therefore be because of the dilution of diagnoses of other tumors due to higher percentage of benign tumors in CBTRUS database. The present study shows a male predominance (65.4%), which is in concordance with other studies with varied age groups from our region [9, 10].

The tumor spectrum in our series varied not only from children to adults but also in different age strata of AYA population. The most common diagnosis in AYA patients was astrocytoma (38.55%) which is in congruence with that of older adults (58.11%). Among the astrocytomas, glioblastoma (GBM) was the commonest in AYA (51.52%), which is similar to that seen in older adults (GBM constituting 84% of all astrocytic tumors). Pilocytic astrocytoma was the most frequent diagnosis in pediatric population (49.1%) and less than 20 years cohort within the AYA patient population (39.58%). In patients with ≥ 35 years of age, GBM (60.24%) was the commonest astrocytic tumor. Incidence of non-astrocytic PCNS neoplasm having a high frequency in the pediatric population was seen to decrease in older cohorts within the AYA population.

IDH1 and 2 mutations, important biomarkers in gliomas [11], are seen more frequently in secondary glioblastoma and in diffuse gliomas [12] with a less aggressive course and relatively better prognosis than in IDH wild variants [13]. In our series, IDH1 mutant glial tumors were seen to be of significantly higher proportion in the AYA population as compared to both pediatric and older adults. MGMT promoter methylation, an important prognostic and predictive marker in high-grade gliomas, has been demonstrated to be present in 30–40% of gliomas [14]. No statistically significant differences were observed in the AYA population in our series for MGMT methylation status as compared to the pediatric and older adults. Loss of ATRX is not only a hallmark of astrocytic tumor, but also a better prognostic factor [15]. In our series, AYA patients had a significantly higher proportion of gliomas with loss of ATRX and these are expected to have better outcomes than pediatric and older adults.

Among the non-astrocytic PCNS in our series, embryonal tumor was the commonest diagnosis in the pediatric population (33.17%), but only the fifth commonest diagnosis in AYA patient population (6.51%). Embryonal tumors were seen more frequently in patients < 25 years of age (57.37%) as compared to ≥ 30 years of age (23.78%) within the AYA cohort. Medulloblastoma was the commonest malignant embryonal brain tumor in AYA patients similar to what is seen in the pediatric age group. Subgroup analysis of 103 medulloblastoma patients of all age groups from our center had revealed SHH to be the most frequent subgroup (48%), followed by group 4 (29%) and group 3 (24%) [3]. While these percentages appear different to the data published from the Western world where group 4 has been shown to be the most frequent subgroup (34%), followed by SHH (28%) and group 3 (27%), these may likely be due to relatively small number of patients in our series and therefore need to be viewed with caution [16]. Brainstem glioma, seen more frequently in patients with age group < 25 years (51.32% of all brain stem gliomas in all age groups), was seen less frequently after 29 years of age (27.63%). PCNSL that constitute 5.74% of PCNS tumors in older adults make up less than 1% of AYA population.

The aim of our study was to highlight the incidence and differences in molecular profiles of various PCNS in AYA population and compare with pediatric and adults. Also, our study reports characteristic molecular profile of various malignant primary intracranial tumors seen in AYA patients and also signifies differences when compared with a pediatric population and older adults. Limitation of our study is the use of hospital-based registry rather than a population-based registry as used in other similar studies [2]. Long-term follow-up and outcomes, while not the aim of the present analysis, are also important and studies such as the present ones may sensitize oncology groups and patient advocates to focus specifically on this patient population.

Conclusions

Our study reports demographic and molecular profile spectrum of primary CNS tumors in AYA patients. Younger patients among AYA population presents with pediatric type of tumor spectrum, while the older ones within the AYA group tend to present with more aggressive histologies. AYA needs special attention and appropriately designed clinical trials need to be performed to improve outcomes taking into account the distinct tumor and patient characteristics of this increasingly recognized patient population.

Notes

Acknowledgements

We thank all our members of our neuro-oncology group as well as neurosurgery colleagues from other hospitals for their patient referrals and management. Special thanks to Ms. Nazia Bano and Ms. Amita Wadwekar for their help in maintaining databases.

Funding information

We are grateful to the Brain Tumour Foundation of India for providing us the financial assistance for conducting the molecular marker research component of the study.

Compliance with ethical standards

Conflict of interest

None of the authors have any conflict of interest to declare or any financial disclosure.

Supplementary material

381_2018_3785_MOESM1_ESM.docx (15 kb)
ESM 1 (DOCX 15 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Rohit Vadgaonkar
    • 1
  • Sridhar Epari
    • 1
  • Girish Chinnaswamy
    • 1
  • Rahul Krishnatry
    • 1
  • Raees Tonse
    • 1
  • Tejpal Gupta
    • 1
  • Rakesh Jalali
    • 1
  1. 1.Neuro-Oncology Disease Management GroupTata Memorial CentreMumbaiIndia

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